The mother: Adaptation to pregnancy and normal metabolism

The mother


Adaptation to pregnancy and normal metabolism


Francesca Parisi, Alice Zavatta, Roberta Milazzo, and Irene Cetin


Introduction


During pregnancy, several maternal anatomical and physiological changes occur in order to ensure proper development of the growing fetus and to prepare the mother for labor and delivery. In this context, maternal adaptation to pregnancy includes numerous cardiovascular, renal, hematologic, respiratory, and metabolic changes that finally lead to increased oxygen and nutrient supply to the fetoplacental unit and to enhanced protection against postpartum hemorrhage for the mother. Table 1.1 summarizes the main mechanisms of maternal adaptation to pregnancy with a systems approach.




















































































































Table 1.1 Maternal adaptation to pregnancy


System


Increase


Decrease


Cardiovascular


Heart rate


Systemic vascular resistance


Blood volume


Systemic blood pressure


Cardiac output


Blood viscosity (Hct and Hb)


Venous stasis


Hematologic


Plasma volume


Protein S activity


Red blood cell mass


Prothrombin time (slightly)


Fibrinogen, factors II, VII, VIII, X, XII, XIII


Hemoglobin concentration


Thrombin activatable fibrinolytic inhibitor, PAI-1, PAI-2


Platelet count (slightly)


D-dimer


Resistance to activated protein C


Renal


Organ volume


Creatinine


Renal blood flow


Natremia


GFR


Urinary frequency and nocturia


Dilatation of the ureters and renal pelvis


Proteinuria and glucosuria


Excretion of HCO3


Respiratory


Minute ventilation


Functional residual capacity


PO2


PCO2


Slight alkalosis


Oxygen consumption


Gastrointestinal


Gastroesophageal reflux


Intestinal peristalsis


Lithogenicity of bile


Gallbladder motility


Serum alkaline phosphatase


Serum level of AST, ALT, γ-GT



Albumin concentration


Metabolism


Insulin resistance


Starving glycemia


Postprandial glycemia


FFA concentration


Cholesterol and triglyceride concentrations


Immunity


Leukocytes count


Leukocytes function


Th2 response


Th1 response


CRP and ESR


Immunoglobulin titles


Moreover, an evolutionary revolution occurred over the last decades: the intrauterine period of development has been shown to permanently shape the adult life, mainly through epigenetic modifications that affect the postnatal phenotype of the offspring in later life (1). This concept has given a new pivotal role to obstetric care also for improving the health status and the risk of chronic disease of future generations. In this context, maternal maladaptation to pregnancy may lead to short-term derangements in intrauterine development, with abnormal fetal growth, birth weight, and morphological development, and may finally shape the risk of chronic diseases of the child and the adult as a long-term effect.


Periconceptional period


Despite the great attention given to the second half of pregnancy, the research focus has recently moved to the first trimester and the time around conception (the “periconceptional period”) in order to grant early screening and diagnosis of subsequent adverse pregnancy outcomes with long-term health effects (Figure 1.1). The periconceptional period represents a chaotic time window from a biological point of view, starting with gamete maturation, going through the events of fertilization and implantation, and ending with the development of the embryonic structures and the first stages of placentation. This period is crucial for a normal adaptation to pregnancy, and any pathological deviation in this time window may finally lead to overt diseases in the second half of pregnancy and to larger shifts in the adult phenotype than the second half of pregnancy. In fact, if it is true that perinatal morbidity and mortality and the risk of noncommunicable diseases are mainly related to complications diagnosed during the second part of pregnancy (e.g., hypertensive disorders, intrauterine growth restriction, preterm birth), it is also evident that these conditions originate during the very first stages of pregnancy and even before, thus involving the most important stages of gamete, placenta, and embryo development (2).


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May 10, 2020 | Posted by in GYNECOLOGY | Comments Off on The mother: Adaptation to pregnancy and normal metabolism

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